Digital Health Is the Euphoria Justified?
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Digital Health Is the euphoria justified? December 2020 Digital Health Is the euphoria justified? Adrita Bhattacharya-Craven, The Geneva Association In collaboration with Adam B. Cohen, Johns Hopkins University Saira Ghafur, Imperial College London Digital Health: Is the euphoria justified? 1 The Geneva Association The Geneva Association was created in 1973 and is the only global association of insurance companies; our members are insurance and reinsurance Chief Executive Officers (CEOs). Based on rigorous research conducted in collaboration with our members, academic institutions and multilateral organisations, our mission is to identify and investigate key trends that are likely to shape or impact the insurance industry in the future, highlighting what is at stake for the industry; develop recommendations for the industry and for policymakers; provide a platform to our members, policymakers, academics, multilateral and non-governmental organisations to discuss these trends and recommendations; reach out to global opinion leaders and influential organisations to highlight the positive contributions of insurance to better understanding risks and to building resilient and prosperous economies and societies, and thus a more sustainable world. The Geneva Association—International Association for the Study of Insurance Economics Talstrasse 70, CH-8001 Zurich Email: [email protected] | Tel: +41 44 200 49 00 | Fax: +41 44 200 49 99 Photo credits: Cover page— Ju Jae-young and IndianFaces / Shutterstock.com Page 31—cawee / Shutterstock.com December 2020 Digital Health: Is the euphoria justified? © The Geneva Association Published by The Geneva Association—International Association for the Study of Insurance Economics, Zurich. 2 www.genevaassociation.org Contents Foreword 5 1. Executive summary 6 2. Introduction 9 3. The digital health landscape 12 3.1. The momentum behind digital health 12 3.2. What does the digital health mass market offer? 13 3.3. How are consumers using digital health? 17 4. The hype versus the facts 18 4.1. Does digital health lead to healthier behaviour? 18 4.2. Does digital health lead to better health outcomes? 20 5. Digital health: Relevance for health and life insurers 22 5.1. A value chain perspective 22 5.2. Online survey results 25 5.2.1. Digital health strategies and opportunities 25 5.2.2. Current digital health platforms 26 5.2.3. Digital health influence across the value chain 27 5.2.4. Barriers to digital health 29 5.2.5. Risks of digital health 31 6. Recommendations: Where to go from here? 32 7. Closing remarks 35 References 36 Digital Health: Is the euphoria justified? 3 Acknowledgements This publication is a product of the Health and Ageing work stream of The Geneva Associa- tion, co-sponsored by Thomas Buberl, CEO of AXA, and Michel Khalaf, CEO of MetLife. We are very much indebted to the members of the Working Group, established in support of the research activities of our Health and Ageing work stream, with special thanks to an advisory group, namely Piet Maree (AIA), Joanna Richardson (AXA), Dr Leena Johns, MAXIS GBN (MetLife) and Achim Regenauer (PartnerRe), who guided the development of this report. In addition, we want to extend our deepest gratitude to all key contributors who helped craft key sections of the report, as well as all survey respondents who provided us with the richness of the data. Contributors include: Achim Regenauer (PartnerRe), Konstanty Owczarek (AIG), Dennis Noordhoek (The Geneva Association), Somesh Chandra (AXA) and Ellie Cole (UCL). Insurer survey respondents include: AIA; AIG, U.S.; AXA, Hong Kong; AXA PPP, U.K.; Ping An; Dai-ichi Life, Japan; DKV, Germany; DKV, Spain; MetLife; Nippon Life; and Prudential Financial. Provider survey respondents include: Daniel Nathrath (Ada Health), Jean Kramarz (AXA Partners), John Korangy (Care Clix), Antonio Sek (Chiron Healthcare Group), Rosaline Chow Koo (CXA), Peter Ohnemus (Dacadoo), George Baptise (DocDoc), Paul Tambeau (Doctor Care Anywhere), Lu (Lucy) Sun (Ping An Healthcare And Technology Company Limited/Good Doctor), Andrew Smith (Grameen Digital Healthcare Solutions, formerly Telenor Health), Group Fit Ventures, Mark Wauton (Global Gene Corp), Paul Feldhausen (Holmusk), Yaron Savoray (KHealth), Kauri Onguchi and Dora Lam (Neurotrack), Tetsuya Nojiri (Oishi Kenko), Jonathan Lau (Pedder Health), Adam Odessky (Sense.ly), Magdalena Llavallol (ÜMA Health) and Y.C. Tsang (UMP Healthcare). 4 www.genevaassociation.org Foreword For the enormous hardship that the COVID-19 pandemic has brought to the world, there are a few silver linings if we look closely. Many industries, for example, achieved accelerated digitalisation as a result of people moving to virtual interactions in their professional and personal lives. Healthcare was one of these industries, and its digital transformation was long overdue. Digital health, with the prospects that it can increase the accessibility and affordability of healthcare, is attractive for individuals, health providers and insurers alike. The research for this report was carried out during a period of sharp and significant growth in the digital health market. Projected increases on the supply and demand sides actually continued to rise throughout the research process. Our research has found, however, that popularity and promise do not guarantee clear, positive, health or financial outcomes. During this period of incredible evolution of the digital health market, healthcare providers as well as payers, like insurers, must prioritise strategies that harness digital health for the benefit of society. This will require a deep investment into understanding the gaps in digital health, such as obstacles thus far to reaching older populations, and how to address them going forward. There are daunting challenges surrounding data – how to integrate data across businesses and the looming issue for insurers of gaining and retaining customer trust. We are pleased to put forward recommendations in this report to help guide insurers on their digital health journeys. Paradoxically, our health systems, perhaps now more stressed than ever, have the potential to soon be more advanced than ever. Insurers should seize this opportunity to contribute maximum value to the physical and mental health of their customers. Jad Ariss Managing Director Digital Health: Is the euphoria justified? 5 1. Executive summary Digital health is already a multibillion dollar market and its growth is expected to continue at an increased rate in the coming years. In general, this growth has been spurred by factors including: improved access to affordable care; rising consumer expectations in a tech-enabled environment; and efforts to control the spiralling costs of care. More recently, the catalytic effects of COVID-19 have further accelerated the uptake of digital health. It is therefore timely for the insurance industry to take stock of its current strategy for digital health and understand how it can be harnessed to support global goals towards improved and equitable healthcare. This report starts by outlining the landscape of the digital health market, focusing on popular consumer-centric solutions as opposed to provider- or payer-centric ones. Subsequently, the impact of digital health on health behaviour and outcomes is explored, and practice, perceptions and strategic considerations for the health and life insurance industry are elaborated upon. The availability of detailed information on the supply-side characteristics of digital health varies by product and region, but there are common headline characteristics: • Mobile apps have created a microcosm in the digital health market. A report by IQVIA in 2017 estimated that 200 health apps are published every day, often with limited regulatory oversight. Wellness apps dominate, but apps for specific health conditions have gained in importance in recent years. However, less than 50 health apps have been downloaded more than 10 million times, suggesting widespread fragmentation in the app market. Mental health, diabetes and cardiovascular diseases (CVDs) are the most popular intervention areas. • Globally, the use of telemedicine has risen rapidly, triggered by the COVID-19 pandemic to provide round-the-clock consultations and advice on routine ailments. According to a report by McKinsey, in the U.S. alone, 46% of consumers now use telehealth compared to just 11% in 2019. In contrast, and beyond COVID-19, telemedicine interventions in Europe have a strong focus on health conditions such as CVDs, diabetes, chronic obstructive pulmonary diseases (COPDs) and obesity. • Asia’s share of the digital health market is on the rise. Funding has doubled from USD 808 million in the first quarter to USD 1,663 million in the second quarter of 2020. China is leading the way, with a sharp rise in telehealth seen during recent months. Countries with fewer resources across Asia and Africa have adopted digital health in areas ranging from financial protection to primary healthcare, often aided by a growing penetration of mobile phones. Digital health is often seen as an antidote to the problems arising from inactive lifestyles. Mobile apps, sensors and fitness trackers promise long- term behavioural change and are most effective when they incorporate the key ingredients of behavioural change techniques (BCTs). However, a survey of mobile apps aimed at the wellness market found that few contained a 6 www.genevaassociation.org balanced spectrum of BCTs. While there is some Online survey